"Although compensation for bone marrow is no longer regulated by the federal government, there are many obstacles it must overcome before it becomes commonplace. Citizens who live in states that ban it may not be able to participate in either end of compensation. This is due to grey areas between the laws of the state governments and the Commerce Clause of the U.S. Constitution. For example, a patient living in a state that bans compensation may not be able to receive bone marrow from a donor who was compensated, even if the donor lives in a state where compensation is allowed, because it breaches the law of the state in which the patient lives. However, this exchange constitutes interstate commerce since the donor and the patient are not in the same state. These types of legal uncertainties often result in cases being heard before the Supreme Court to determine precedents for similar scenarios in the future.36

"Then there are the practical difficulties. At the moment, no compensatory bone marrow registries exist. According to Doug Grant of Hemeos, the main reason for that is that the NMDP opposes the compensation of bone marrow. Both MoreMarrowDonors.Org and Hemeos, despite having had different business plans in the way they were planning on going about compensating donors, were forced to close because of procedures indirectly imposed on them by Be the Match. Grant told me in an interview that he closed Hemeos in February 2017 because as a startup, the fight against regulation was too much for Hemeos to overcome. By the time that compensation became unquestionably legal, the startup had run out of capital. For compensation to become a reality, there must be registries that are willing to compensate. Because the NMDP so strongly opposes compensation, the experts I talked to agreed that the only option for a compensatory bone marrow registry to exist is for it to be a competitive, parallel registry to that of BE the Match.

"This presents other logistical difficulties because currently Be the Match is the registry that most,if not all,physicians use when looking for a match for their patient. For a new registry to compete with Be the Match, not only would it, like Hemeos, have to develop its own software to provide transplant centers with, but it would also need to make connections with individual hospitals so that they begin to search the registry. Growing a registry to fully compete with Be the Match’s could take years given that there is nocentralized process by which hospitals partner with bone marrow registries. Each hospital would have to make an individual partnership with the compensatory registry. Furthermore, there is currently little incentive for entrepreneurs to tackle this seemingly daunting startup possibility since the entire bone marrow market accounts for only $3 million to $4 million a year.
...
"Lastly, as previously mentioned, 47 percent of the matches made by Be the Match include either a foreign donor or recipient. Compensation poses a problem in those cases because many of the cooperative registries that partner with Be the Match are national registries of countries where compensation is not legal. By making compensation legal in the United States, some of these partnerships could be strained, potentially leading to a significant loss of international matches. All of these are barriers that would need to be somehow overcome in order for compensation not only to be realistic but also for it to accomplish its goal of helping to relieve the scarcity of bone marrow matches."
********